The good and bad cholesterol

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"Dyslipidemia" is a complicated-looking word for what most people simply call high cholesterol. Actually, it's a bit more complicated than that, since "high" and "low" don't tell the whole cholesterol story. To make sense of "physician speak", "dyslipidemia" can be broken into parts: dys, which means disorder; lipid, a fatlike substance (e.g. cholesterol), and emia, a term pertaining to the blood. "Dyslipidemia", then, is a disorder of fatlike substances in the blood.

Numerous studies have linked abnormal levels of cholesterol in the blood to a person's likelihood of developing coronary heart disease (CHD). A full 50% of American adults are at risk of developing CHD. What dyslipidemia is and how you "get" it, as well as measures you can take to prevent or counteract unhealthy cholesterol levels in order to lead a long and full life, are discussed in this article.

THE HIGHS AND LOWS OF CHOLESTEROL
Contrary to popular belief, not all cholesterol is bad. High levels of one type of cholesterol signal greatly increased chances of developing heart disease, while high levels of another act to prevent heart disease. Let's see why this is so.

Triglycerides and cholesterol are the lipids of primary concern for our discussion. Oils and fats in the foods and excess calories from other foods are the main source of triglycerides, which are stored in fat cells until the body converts them into heat energy.

White, waxlike substances are used to make hormones and cells. Cholesterol is produced in your liver and intestines, though the food you eat also contributes to the body's cholesterol supply.

Everyone knows that oil and water don't mix, and since blood is chiefly water, triglycerides and cholesterol must be transported through the bloodstream by special proteins know as lipoproteins. Low-density lipoproteins (LDLs) carry cholesterol known as LDL cholesterol to cells outside the liver. Often called "bad cholesterol", it can result in cholesterol deposits on artery walls when its levels in the blood are too high. These deposits eventually clog arteries, the most susceptible of which are the coronary (heart) arteries.

High-density lipoproteins carry HDL cholesterol, the "good cholesterol", which is thought to remove excess "bad cholesterol" from cells and take it back to the liver. There it's broken down and expelled from the body, or reused.

An easy way to remember the "good" from the "bad" is this: Persons with dyslipidemia should strive to keep their HDLs high and their LDLs low.

WHAT CAUSES DYSLIPIDEMIA?
Various underlying causes have been cited for dyslipidemia. Heading the list are life-style factors. Sedentary work and leisure time, minimal exercise, high-fat, high-sugar diets, smoking, and alcohol consumption all contribute to unhealthy levels of cholesterol in the blood. For suggestions as to how to improve your diet and thereby enhance your health, see the section "Total Health Nutritional Program" later in this article.

Certain medications for hypotension (low blood pressure) and birth control pills have been linked to elevated total cholesterol levels. Genetic disorders associated with 30% of CHD cases and several nongenetic disorders, such as estrogen deficiency and hypothyroidism (deficient activity of the thyroid gland, characterized by lethargy and lowered metabolism) are other causes.

Estrogen deficiency is common in post-menopausal women and those who have undergone complete hysterectomies. Estrogen has a stabilizing effect on cholesterol metabolism, keeping LDL levels low and HDL levels high. Studies have shown that women face an increased rate of heart disease following menopause due to their "estrogen deficits." Physicians often advocate estrogen-replacement therapy to prevent dyslipidemia, but the potential for harm inherent in this approach makes it less than desirable. In resent years, women have been rightfully hesitant to embark on an estrogen regimen, since use of synthetic estrogen has been linked to breast and uterine cancer. Moreover, estrogen-replacement therapy is contraindicated for women with a history of breast cancer.

WHY DYSLIPIDEMIA IS UNHEALTHY
Cholesterol begins to build up on artery walls when ore of it is delivered by LDLs than can removed by HDLs or utilized by the cells. Scar tissue and other debris also attach to the walls, thickening them over the years. Some arteries actually become blocked, a condition commonly known as hardening of the arteries, or atherosclerosis.

Eventually, the arteries in the heart also become blocked, preventing the blood from supplying the heart with the oxygen and nutrients it needs. If this process continues, a major artery may become obstructed, and a heart attack will result. If an artery to or in the brain becomes clogged, a stroke is likely to occur.

DYSLIPIDEMIA AND HEART DISEASE
Studies from Finland to Israel have shown a strong correlation between high levels of LDL, low levels of HDL, and the likelihood of developing coronary heart disease (CHD). Heart attacks are most likely to occur in persons whose total cholesterol blood levels are between 210 and 265 and/or those whose HDL cholesterol blood levels are below 35. The good news is that, for every 1% decrease in total cholesterol levels, there is a corresponding 2% decline in the incidence of CHD.

But good health is more than a numbers game. A combination of good nutrition, regular exercise, and natural, herbal therapy can go a long way to reducing your chances of becoming a statistic.

TOTAL HEALTH NUTRITION PROGRAM
One can hardly overemphasize the importance good nutrition plays in the prevention of dyslipidemia and a recovery from it. What's more, eating a healthy, low-fat diet will most likely result in weight loss. You'll not only look and feel better, but since excess weight has been linked to CHD, you'll increase you chances of living longer to enjoy your new body.

General guideline are:
Choose foods which are low in fat. When selecting a cooking oil, look for a vegetable oil which is high in polyunsaturated fats.
Choose only lean meats, fresh or frozen seafood, and water-baked fish. Limit shellfish, lobster, and shrimp to two times a week. Prepare meats and fish by broiling or baking, avoiding frying which adds unnecessary fat.
Egg substitutes and egg whites may be eaten without guilt. Yolks should be used sparingly, no more than four per week.
Most fruits and vegetables may be eaten freely, though you should avoid avocados and olives, which are high in calories and monounsaturated fat. Starchy vegetables, such as corn and lima beans, should be eaten sparingly.
Choose whole grain or enriched breads, high-fiber cereals, and oat bran. Steer clear of sugary cereals.
Avoid snack foods and sweets.
EXERCISE
Not only does exercise help you shed pounds, but it simultaneously helps raise HDI levels in the blood, thereby diminishing your chances of heart disease on two fronts.

NATURAL THERAPIES
Though several synthetic drugs are used to treat dyslipidemia, many people today are seeking natural therapies to supplement conventional treatments. The therapies discussed below are not meant to replace any medicines prescribed by your physician.

CHROMIUM
Use of the mineral chromium has been shown to lower cholesterol and triglyceride levels and correct abnormal glucose tolerance. Chromium deficiency is known to cause a severe metabolic dysfunction which mimics dyslipidemia and is characterized by elevated total cholesterol and triglyceride levels, decreased HDL levels, and abnormal glucose metabolism. This dysfunction is especially prevalent in populations like our own which have diets high in processed foods.

As we have seen, there is hope. It is not necessary to ignore what could potentially be a serious medical problem. Be sure to explore treatment possibilities with your physician, though he or she may not have the knowledge to explore natural, time-honored therapies. Be an informed medical consumer and ask questions. You deserve a healthy, happy life free from worry over drug side effects.

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By Harinder Grewal, M.D.

Harinder Grewal, M.D. is Medical Director of the Women's Total Health Centers, located at 500 S. Anaheim Hills Rd. #200, Anaheim Hills, CA 92808.

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